tag:blogger.com,1999:blog-30499448.post1415036969365749564..comments2015-07-27T08:02:52.947-07:00Comments on Surgeonsblog: Time For Tears, Tears For TimeSid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.comBlogger13125tag:blogger.com,1999:blog-30499448.post-24934569120528347322008-03-24T16:53:00.000-07:002008-03-24T16:53:00.000-07:00Wonderful post Sid. As our residents mature and en...Wonderful post Sid. <BR/><BR/>As our residents mature and enter their later years in training I occasionally witness the emergence of a resident I know will be destined to be a "master" surgeon. They may not have the best hands of the bunch, but they certainly have the talents to accomplish what needs to be done. What I feel sets them apart as the masters is the fact that they begin to wonder who we should not operate on and begin to question us openly about the cases that they once would have dove right on into without thinking twice. They start to understand that a person has placed themselves in our hands to improve their quality of life and they start to understand the importance of the paternalistic side of medicine so many of us shy away from or deride.Howardhttp://www.howardluksmd.com/journal/noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-22997683559701712552008-03-19T21:56:00.000-07:002008-03-19T21:56:00.000-07:00No one writes like you Dr S. you are obviously suc...No one writes like you Dr S. you are obviously such a wonderful doctor and I think these posts do much to enlighten others pursuing surgery.<BR/><BR/>You would also be an amazing instructor imparting not only the physical techniques but also the emotional perspectives and ethics of the profession.<BR/><BR/>I couldn't help thinking about our aunt still wrestling with cancer. She has been valiantly fighting it for 19 months now. it is no longer in her breast,groin or neck but still in the liver. it's not better and not worse and they were going to give her a break but she was slurring her words and not feeling right and they found that she has lesions on her brain. So they immediately started her on chemo for that and she started feeling better in a couple of days.<BR/><BR/>But she is still so weak and thin but with a great attitude and smile. i am amazed at how they keep coming up with something new and tell her they still have other things they can do.<BR/><BR/>I have a question but I don't want to give power to the words. Besides I think I know the answer anyway.SeaSprayhttp://www.blogger.com/profile/07906503090688697222noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-89107138636416981622008-03-19T07:52:00.000-07:002008-03-19T07:52:00.000-07:002nd year vet: thanks for another perspective. It's...2nd year vet: thanks for another perspective. It's a good example of a dynamic that's not unique to your field.Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-71930034406573451512008-03-19T06:16:00.000-07:002008-03-19T06:16:00.000-07:00This topic is so fluid, and can and has changed so...This topic is so fluid, and can and has changed so much. I feel (hope?) that most of my undergrad classmates who went on to med school went there not with the idea of fighting death, but fighting illness. I think there's a big difference, and that for a long time human medicine was more focused on the former rather than the latter.<BR/><BR/>This is becoming a huge issue even in the veterinary medical field, ironically in the opposite direction. Euthanasia used to be the clearly "right" choice in many situations where now a pet owner may feel pressured to spend the many thousands of dollars on surgical, medical, or (God help us) even CAM care for their animal. I feel very strongly that many people are condemning their animals to a long and painful bout of suffering before inevitable death. I'm all about informed and reasoned consent, (obviously within reason in vet med). An animal is incapable of telling you that they understand that they next few months will be painful, but they want to do everything they can to prolong the time they have left with their family. All they know is that they're in pain. We as veterinarians are clearly not treating our patients, but their owners. It's one of the many reasons I'm not going into small animal practice. I find it very hard to stomach someone coming in for chemotherapy to treat the lymphoma in their 16 year old Boston terrier with congestive heart failure, chronic renal failure, hepatic insufficiency, etc.2nd year vet studentnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-54435987021667979432008-03-19T05:45:00.000-07:002008-03-19T05:45:00.000-07:00As per Dr David. The best surgeons will know when...As per Dr David. The best surgeons will know when NOT to operate, but it's not so easy in every case. Nicely written post.Buckeye Surgeonhttp://www.blogger.com/profile/15650563299849196122noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-62286947513036564922008-03-18T18:55:00.000-07:002008-03-18T18:55:00.000-07:00Great post, Sid. The line I liked the best is thi...Great post, Sid. The line I liked the best is this: "It's not about 'what can I do.' It's about 'what ought I do.' " You're so right. So many times, there are things we can do... but those things may not be the right thing to do. Sometimes "the right thing to do" is nothing... and that can be SO hard for a physician. Even for us pediatrics/medicine types.Doctor Davidhttp://www.blogger.com/profile/05561641468831789428noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-57839320862451492922008-03-18T10:51:00.000-07:002008-03-18T10:51:00.000-07:00I am just finishing Jay Katz' book from the 1980's...I am just finishing Jay Katz' book from the 1980's "The Silent World of Doctor and Patient". He speaks to the difficulty of informed consent when doctors can't really listen because of the role we are in...Patients put us in, the history of the profession has come to, the training...To truly listen to the patient, their fears, needs, desires, is only possible when we (physicians) are at peace with our own. Alot to ask of non seminary professionals...But still, we do claim a powerful position.<BR/>Nice post. <BR/>I believe "palliation" (=) comfort is a very noble goal. It just needs to be shared, accepted, understood. "Cure" is the one I am suspicious of....Sounds too much like over promising...DDx:dxhttp://www.blogger.com/profile/05744917175160791044noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-90395543159207676602008-03-18T10:26:00.000-07:002008-03-18T10:26:00.000-07:00Surgeons may wish to come riding in on their white...Surgeons may wish to come riding in on their white horses over the rough ground, but the best ones dismount and walk beside their horses so that they can look directly into the eyes and hearts of their patients, can hold their hands, and can guide them over the hurdles.<BR/><BR/>You are one of the rare ones, Dr. Schwab. Thanks for walking that most difficult walk so gracefully and sensitively. :^)Anniehttp://revolutionredux.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-62942041004725331472008-03-18T10:08:00.000-07:002008-03-18T10:08:00.000-07:00A very thought provoking post. You gave me a fasci...A very thought provoking post. You gave me a fascinating look into the mind of a surgeon on this topic, and material for my own blog as well. I can only hope that should I ever need more surgery, my surgeon will be as thoughtful as you.Amyhttp://www.blogger.com/profile/12284118546945370615noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-87387764970012355342008-03-18T08:33:00.000-07:002008-03-18T08:33:00.000-07:00Dr Sinclair: I read her book, too, and did a revie...Dr Sinclair: I read her book, too, and did a review of it for Medscape. It's there, somewhere. I disagreed in some places, particularly her emphasis on doctors' own fear of death preventing relating to the dying. <BR/><BR/>The subject of mortality statistics affecting surgeons is a good one: I think I've written a little about it, tangentially; but it deserves a post of its own. I did a series on death a while back,<BR/><BR/><A HREF="http://surgeonsblog.blogspot.com/2007/04/on-death-one.html" REL="nofollow">here</A>, <BR/><BR/><A HREF="http://surgeonsblog.blogspot.com/2007/04/on-death-two.html" REL="nofollow">here</A>, and<BR/><BR/><BR/><A HREF="http://surgeonsblog.blogspot.com/2007/04/on-death-three.html" REL="nofollow">here</A>.Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-81567359402114588672008-03-18T05:00:00.000-07:002008-03-18T05:00:00.000-07:00Dr. Sid, once again you have written beautifully o...Dr. Sid, once again you have written beautifully on a difficult subject. I would only echo both the previous comments.rlbateshttp://www.blogger.com/profile/15236331355857884458noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-11667749370050698142008-03-17T23:21:00.000-07:002008-03-17T23:21:00.000-07:00After eight years of metastasized non-Hodgkins, di...After eight years of metastasized non-Hodgkins, diagnosed on her 40th birthday, my sister-in-law had palliative surgery, with the result that she managed to live long enough to see her son get married to a girl she adored too. To her and each one of us, that surgery was worth every extra day.AlisonHhttp://www.spindyeknit.comnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-60224667939750680022008-03-17T21:36:00.000-07:002008-03-17T21:36:00.000-07:00Sid, Excellent post on a tough subject. I recentl...Sid, <BR/><BR/>Excellent post on a tough subject. I recently have been having some conversations with a local surgeon about how much of surgery is really palliative in nature and not curative when you start looking at therapies with a much broader definition of palliative.<BR/><BR/>I would almost consider flipping what is the common understanding of what physicians do by saying we are mostly palliative and sometimes curative. (Of course there are many arguments as to why this is not completely true). I think we as doctors do not give our selves enough credit for palliation as an achievable goal of medicine in general.<BR/><BR/>I agree heartily with your statement and paragraph beginning with "It's imperative both to lead and to follow." For those who trumpet autonomy and deride paternalism, they fail to realize there are times when both are needed and surely times when the two are used exclusively of the other. Therein lies the art of communication in medicine.<BR/><BR/>I just <A HREF="http://www.pallimed.org/2008/03/interview-final-exam-author-pauline.html" REL="nofollow">interviewed a surgeon who authored a book</A> (<I>Final Exam</I>) on mortality in surgery (in fact I posted it this morning). She focuses more on dealing with death in dying and not so much on the issue of palliative surgery in her book. Although she did inform me that the ACS (with Jeff Dunn, I think) is starting to focus on palliative surgery and surgeons can now become board certified in palliative medicine.<BR/><BR/>For others interested in this book or interview you can see them at <A HREF="http://www.pallimed.org" REL="nofollow">Pallimed. </A><BR/><BR/>I would offer to interview you on Pallimed Sid, but you have such great writing over here, I usually just direct people here!<BR/><BR/>If you ever get a chance to discuss how mortality rates and statistics may influence surgeons, I would love to hear your thoughts on that.Christian Sinclair, MDhttp://www.blogger.com/profile/14685043408496367587noreply@blogger.com